While other cities are charging ahead to create integrated healthcare systems for the poor and uninsured in preparation for healthcare reform, little is being done in the Miami area because the system is “fragmented,” according to a new report from the journal Health Affairs.

What’s more, while public hospitals in other areas often lead the community in coordinating care, Jackson Health System, “the primary safety-net hospital for Miami-Dade County … generally does not provide a leadership role,” said the the study, sponsored by the Washington-based Center for Studying Health System Change.

Integrating healthcare is critical for communities trying to control soaring healthcare costs by making sure the poor and uninsured have access to routine healthcare so they don’t have to seek care in emergency rooms, where care is much more expensive. Miami-Dade taxpayers currently fork over about $350 million a year to Jackson for charity care.

Jackson’s chief medical officer, Michael Butler, objected to the Health Affairs assessment of Jackson’s failure to lead. He said the system had been working hard with others providers to coordinate care. “We’re always partnering with the community.”

Added Lillian Rivera, administrator of the Miami-Dade County Health Department, who has been pushing for the need for more coordinated care: “We are making progress. We need to make sure we all work together.”

The study says the key to better care is clinics and hospitals working together to coordinate efforts so that the poor and uninsured can quickly get the level of care they need without having to fight a different bureaucracy at each step.

One huge step — which Miami-Dade entities are still struggling to launch — is to create a single application process so a patient can fill out one application and then get a card for charity care, or Medicaid, that would be recognized by all healthcare organizations in the county. That would allow an uninsured person to be assigned a “medical home,” a dependable source of primary care.

Peter Cunningham, the study’s lead author, said lack of leadership is “the underlying problem that we saw in Miami-Dade… There just seem to be a lot of different entities, both government and nonprofit, that seemed to be doing something, but … nobody seems to be in overall charge.”

Cunningham and several local healthcare leaders say that on paper the responsibility for coordination seems to fall on the Miami-Dade Health Action Network. The little-known network consists of 68 members, including major hospitals, clinics and the two medical schools. But the network has no funding or employees, said Marisel Losa, chief executive of the Health Council of South Florida, which handles the network’s operations in addition to other healthcare work.

“We’re just the guys behind the scenes trying to get things accomplished,” said Losa. The council, funded by a combination of state and federal money plus grants, has 15 employees and $1.4 million in annual revenue, according to 2010 Internal Revenue Service documents. About $1 million of that goes to salaries, the documents say, with Losa earning $133,856 annually.

Losa said her group began working toward a unified application process in 2008 after seeing the concept in action during a trip to San Francisco. That trip led to the formation of the health action network.

The Miami-Dade leaders learned that Palm Beach County health authorities were already working on a similar concept, so the network began trying to follow Palm Beach’s lead. The council hopes to start pilot project next year, Losa said. Jackson hasn’t yet agreed to participate, she said.

Butler, Jackson’s chief medical officer, called the single application “a good idea,” but said he wasn’t certain how it would work, since various government and charity programs have different requirements for documentation.

Some healthcare leaders say the the health council doesn’t have the political power to push through changes to coordinate care in the county. “No, not yet,’ said Linda Quick, who headed the council from 1982 to 1994 before becoming president of the South Florida Hospital and Healthcare Association.

Quick said the council’s funding had been “hand to mouth and year to year,’’ which hurt its ability to command enough respect among major healthcare providers to get things done.

Cunningham, the Health Affairs author, said many other areas of the country are years ahead of Miami-Dade. He said that when Health System Change investigators visited Miami-Dade in 2010, they found “all kinds of organizations vying for influence… There are certainly individuals and organizations that are well meaning and working hard, but I just don’t know if they have the clout in the community to get things done.”